Craniofacial surgical resection: new frontier in advanced head and neck cancer

Craniofacial surgery has revolutionized the management of extensive malignancies and histologically benign but locally invasive tumours which encroach upon or directly invade the undersurface of the brain case. Approaches have been devised for tumours that involve the anterior middle and posterior fossae. Teamwork between head and neck and neurological surgeons is essential. Comprehensive pre-operative evaluation, especially the adequacy of cross-fill of the cerebral circulation via the contralateral arterial system through the circle of Willis, must be done. Management of the internal carotid artery and cavernous sinus presents the most difficult surgical problems during the resection. During the closure, separation of the intracranial dissection from the paranasal sinuses and epipharynx by the use of flaps and grafts is essential to prevent cerebrospinal fluid leakage, cerebral support, and isolation of the carotid and dura from upper respiratory tract organisms. Well-planned and executed craniofacial surgery can be done with acceptable morbidity and mortality rates and reasonable survival rates.